Fluid-Structure Interaction Simulation of the Edge-to-Edge Repair of the Mitral Valve in Functional and Degenerative States

The most common dysfunction of the mitral valve (MV) is mitral valve regurgitation (MVR) which accounts for approximately 70% of native MV dysfunction [1]. During closure, abnormal amounts of retrograde flow enter the left atrium altering ventricular haemodynamics, an issue which can lead to cardiac related pathologies. MVR is caused by a variety of different mechanisms which are either degenerative (myxomatous degeneration) or functional (annular dilation or papillary muscle displacement) [2]. Correction of MVR is performed by repairing existing valve anatomy or replacement with a prosthetic substitute, however repair is preferred as mortality rates are reduced (2.0% against 6.1% for replacement) along with other valve related complications [3]. A common and popular method of repair is the edge-to-edge repair (ETER), which aims to correct MVR by surgically connecting the regurgitant region through reducing the inter-leaflet distance. Although MV function is improved in systole, induced stresses are significantly increased in diastole where the MV is typically in a low state of stress. In order to assess the effect of this technique in diastole, where the dynamics of both the MV and ventricular filling are disrupted it is required to use fluid-structure interaction (FSI) modelling techniques. Here a FSI model of the of the MV has been described, using this model the resulting induced stresses from the ETER in both functional and degenerative states of the MV have been simulated and assessed using the explicit finite element code LS-DYNA.